Recognizing Aspergers or NLD

No two people with Asperger’s Syndrome (AS) or NLD are alike. People with AS and NLD are usually enjoyable bright people who bring unique insights and hard work to any task they undertake. However, the official diagnostic criteria for AS or NLD focuses on challenges, so in this post I share some of the experiences I’ve had with clients that I hope bring this criteria to life. There are differences between NLD and AS, but these experiences tend to be shared.

They miss social cues and misjudge social situations. One boy would do things he thought were OK and miss that look or tone of voice from a teacher that say’s “I’ve had enough.” He’d get yelled at and complain his teachers were “unfair” and “hated him.” For a spouse, thinking a caring or thoughtful partner should “know” what to do is unrealistic.

Feelings can seem illogical. We combat this by coming up with strategies to cope. One of my adolescent patients and I agreed that he would get out his phone when the conversation turned to feelings. This was socially acceptable and less likely to alienate his peers than what he had done before, which was to say that the discussion was stupid.

They have difficulty with theory of mind, the idea that someone else has a different point of view that might be as valid as their own. I had a friend with NLD who felt he was doing me a favor by telling me what I was wearing was unattractive. The idea that this was his opinion and I didn’t want to know didn’t make sense to him. He thought he was helping.

They can seem inflexible, which I call “railroad track” thinking.” They get fixed on an idea or expectation, relying on routine and solutions they’ve developed to handle the constant curve balls thrown at them by life. One boy had a melt down because his mother hadn’t told him the front door was being repainted a different color. A girl accused her mother of lying because they weren’t going for ice cream as promised.

They tend to have repetitive behaviors, such as areas of obsessive interest. It can be a liability when peers don’t share this interest; it’s a benefit when interests can be translated into a career. I had this work both ways for a young man I saw. He was gifted in music and had created a new tonal system that guaranteed acceptance into graduate school. Unfortunately, lacking social judgment, he would launch into monologues about it even when listeners didn’t want to know all the details.

They are detail-oriented, think literally and miss inferences of what’s stated. An NLD boy I evaluated was seen as hostile and oppositional because he asked, “What does this have to do with social studies” when his teacher showed a short funny movie as a break. He wasn’t being rude; he was being literal and simply wanted to know the answer.

They are often perfectionists. I was testing a young man who wouldn’t stop working on a single problem until he had solved it; a test that usually took seven minutes took an hour and a half.

They have a strong sense of logic and fairness, but can balk at rules that don’t make sense and seem unfair. I had a young patient who was very upset because the rule in his cafeteria was that he had to eat his sandwich before his dessert. Since he always ate both and they end up in the same place, this didn’t make sense and he argued. We had to agree that always getting into trouble at lunch wasn’t worth it.

They are truthful, even when the timing is inappropriate. Many of my clients have problems with social niceties such as saying, “Nice to see you,” or “See you again” if it isn’t or they won’t. One of my teenaged patients attending a family Easter dinner picked that discussion to share that she no longer believed in God.

Other typical challenges include sensory hypersensitivity to textures, tastes, sounds, visual stimulation and physical contact. One of my kids won’t wear pants with tight waists like jeans or socks with seams; his mom dresses him in sweats for school. He’s also a picky eater because of the taste or texture of food.

They can be sensitive and overreact to what they perceive as a threat or a humiliation. A comment can be taken as mean when it was innocuous or part of everyday social banter. Since they’re often bullied, it can be hard to know. One high school boy was suspended because he threatened to beat up a girl who provoked him. It’s critical that AS and NLD kids are protected from bullying.

They can get stuck on ideas so it’s difficult to let go of offenses. One young man had what we called a “filing cabinet” of all the past offenses of his family, which he would recite whenever they argued. Another, a substitute teacher, never forgot a single time he felt slighted when passed over by a school or criticized. Both had to learn to “let go” to thrive.

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